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Do I Need a Lower Facelift at 36, More Fillers, or Chin Implant? (photo)

I just turned 36, One side of my lower face sags much worse than the other one. One side of my face is thinner. I recently got 1 siringe of Radiesse to fill my cheeks and 1 s. of juvederm to fill the sides of the nose. However the filling of the cheeks did not help at all lifting the lower face. Im worried adding more radiesse would make me look overly done. What are my options, is my chin possibly too small? do I need fillers, or a face lift. I want to do something before it gets way worse.

Doctor Answers (17)

Facelift at 36?

+2

   Facelift at 36 would improve the lower face.  However, the top fat component you have is buccal fat pad fat, and a portion of this can be removed as well.


Los Angeles Plastic Surgeon
5.0 out of 5 stars 178 reviews

Beware of fillers in the lower face

+2

Thanks for your photos.  At your young age, the early jowling can be exacerbated by too much filler injected into the cheeks.  Beware of adding inappropriately placed volume to the cheeks where it can make your cheeks heavier and eventually settle into the jowls with gravity.  Unfortunately, there are many injectors who don't understand this relationship, and many more are likely to add to this problem. 

Randy Wong, MD
Honolulu Plastic Surgeon
5.0 out of 5 stars 15 reviews

Do I Need a Lower Facelift at 36, More Fillers, or Chin Implant?

+2

 Aesthetically speaking, from the photos provided, the cheeks are flat and the chin is weak.  Chin Augmentation with a Chin Implant would augment the chin and balance the lower face.  I prefer using Perlane to augment the cheeks, which could be more full anteriorly but no fillers of Cheek Implants will lift sagging tissue from the jowls.  Only a Face Lift will do that.  

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.5 out of 5 stars 12 reviews

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Lower facelift and chin implant for facial sagging skin.

+2

Lower facelift and chin implant for facial sagging skin would be best for your receded chin and sagging skin. I do not think a cheek lift is indicated for what you have which is well below the cheek.

 

 

 

 

 

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 14 reviews

Do I Need a Lower Facelift at 36, More Fillers, or Chin Implant?

+2

It is important to understand that all humans have asymmetry in their face and if your goal is to have a perfect match between the two sides, you will always be frustrateed because it cannot be done. See 2-3 surgeons for consultation and examination and get a feel for what can be realistically be accomplished. The small differences visible in the picture are well within the normal range of asymmetry.

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 12 reviews

Fat Grafting??

+2

 At 36 yo most patients are probably going to hold off on surgery and continue with facial fillers. Eventually, you most likely will most likely desire surgical intervention but, be patient. Fat grafting to the face with facial liposuction to contour areas may provide you with the greatest benefit at this young age. Best,

 

 

Gary R Culbertson, MD, FACS

Gary R. Culbertson, MD
Columbia Plastic Surgeon
5.0 out of 5 stars 3 reviews

Most syringes of dermal filler are equivalent to 1cc= 1/3 of a teaspoon

+1
The amount of filler you received is not as much as you might think. Each syringe of filler is equivalent to about 1cc which is 1/3 of a teaspoon. This is likely the reason you did not experience lifting in your midface region after one syringe of Radiesse. Based on your images alone you may be a candidate for additional dermal filler to midface and smile lines. However I would recommend you see a facial plastic surgeon who specializes in the artistry of fillers. The location and type of filler makes a big difference in how your face is shaped. Not all fillers create the same effect, and not all injectors can enhance your face the way you want. It’s important to find someone who understands how to use the fillers in an artistic manner.
Based on the angles of your photographs it is difficult to determine whether or not you would benefit from a chin augmentation. A chin implant increases the projection of your chin but does not increase the vertical height. Many times increasing the vertical height will achieve more balance, especially in someone who already feels their lower face is sagging. I would recommend consulting with a board certified facial plastic surgeon. They will be able to evaluate your anatomy in person and design a customized treatment plan to best meet your needs.

James Chan, MD
Portland Facial Plastic Surgeon
5.0 out of 5 stars 30 reviews

Ultherapy: A New Treatment that's Delivering Excellent Results

+1

You may want to consider taking a break from the fillers. As an alternative, I’d suggest consulting with a plastic surgeon to see if you’re a good candidate for non-surgical Ultherapy. That's because your situation calls for a focus on the lifting and tightening of lax skin. Still, fillers may present a contraindication to Ultherapy that calls for waiting until the Radiesse and Juvederm have been eliminated by your body. Ultherapy is a non-invasive procedure that uses targeted ultrasound energy to stimulate natural-looking lifting, tightening and toning. The younger a patient is, the better he or she will respond to the ultrasound therapy. Meanwhile, this treatment is designed specifically to address the drooping cheeks, emerging jowls, and sagging chin that concern you.

 

Hal Michael Bass, MD
Pembroke Pines Plastic Surgeon
4.5 out of 5 stars 28 reviews

Face lift fillers loose skin

+1

It is unusual that a patient at age 36 can benefit from a face lift.

Fillling of the cheeks with the so called vector lift can improve the geometry of the face but would require abnormal amounts of filler to produce the tightening that most patients request.

Reliable options are liposuction of the jowls to smooth the jawline and give some skin tightening as well as the use of the Cellulaze Sidelaze for tightening of the lower face and neck. 

Please consult in person with an experienced Board Certitifed Plastic Surgeon prior to making treatment decisions.

Luis A. Cenedese, MD, FACS
New York Plastic Surgeon
4.0 out of 5 stars 11 reviews

Facelift or filler for the lower face? Fillers don't pull or tighten.

+1

Thanks so much for the photos. I'm sorry you didn't have more success with the Radiesse. Unfortunately fillers don't pull or tighten anything they just fill. Some patients whose main concern is the sagging along the jawline with early jowl formation could try having the depression in front of the sag filled to camouflage it - but proceed with caution if you decide to go this route since adding more volume to the jowl area can make the problem look worse and add unnecessary bulk to the jawline. I personally would not recommend this for you based on your photos.

The obvious question you raised is should you ideally have a facelift to tighten your jawline. The answer would be a definite yes if you were 50 but a cautious maybe at your age of 36. It would be the most effective option for improving the lower face sagging you describe, but with the highest risk and longest recovery time. A chin implant might improve your result - although more photos including a profile view would be helpful.

Don't rush into it and educate yourself as you are doing here. The video below explains the short incision approach to lower facelift - certainly not minimally invasive - but less invasive than a longer incision facelift that is used for patients who have significant neck sagging.

Thomas Buonassisi, MD
Vancouver Facial Plastic Surgeon
5.0 out of 5 stars 56 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.